Non-embolic ischaemic cerebrovascular disease in Nigerians

In the 11-year period, 1957–1968, 235 patients with non-embolic cerebrovascular disease have been seen in the University College Hospital, Ibadan. In the same period, at least 200,000 patients have been treated in the various departments and wards of the hospital. Non-embolic ischaemic cerebrovascular disease constitutes 49.8% of all cerebrovascular disease seen at the hospital. The incidence in the hospital population is 1:850. It forms 7% of all neurological admissions and 0.15% of all admissions. The peak incidence is in the age group 50–59 years. Eighty-one per cent of the patients are over the age of 40. The male to female ratio is 1.8:1. A third of the patients come from the upper and middle socio-economic classes. Hypertension was present in two-thirds of the patients, diabetes mellitus in one-fifth. Only 26% of the patients were normotensive and non-diabetic. The prognosis in transient ischaemic attacks in Nigerians is worse than that reported in Caucasians. The clinical features are briefly described and the frequent absence of a Babinski response is noted. The serum cholesterol is higher in these patients when compared with the level found in Nigerians from low socio-economic groups, but is not higher than the level found in Nigerians from the upper and middle socio-economic groups. The mortality rate in this series was 15.3%. Sequelae included severe disability (10%), epilepsy (3.4%) and the thalamic syndrome (1.7%). Non-embolic cerebral disease is not rare in Nigerians, and diabetes mellitus and hypertension are by far the most important predisposing factors.